{
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"EIN": null,
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"IsOrgSubpart": "Y",
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"OtherCredential": null,
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"FirstLineMailingAddress": "222 PARK PL",
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"MailingAddressCityName": "WAUKESHA",
"MailingAddressStateName": "WI",
"MailingAddressPostalCode": "53186-4858",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": null,
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "222 PARK PL",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "WAUKESHA",
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"PracticeLocationAddressTelephoneNumber": "651-829-2240",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "02/24/2025",
"LastUpdateDate": "02/24/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BALL",
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"AuthorizedOfficialTitle": "PHARMACY MANAGER",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "651-829-2240",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336L0003X",
"TaxonomyName": "Long Term Care Pharmacy",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}